Provider Demographics
NPI:1447289590
Name:DAGENHARDT, HOLLEY ANDERSON (MA, RD, LDN)
Entity type:Individual
Prefix:MRS
First Name:HOLLEY
Middle Name:ANDERSON
Last Name:DAGENHARDT
Suffix:
Gender:F
Credentials:MA, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:618 2ND ST NE
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-3856
Mailing Address - Country:US
Mailing Address - Phone:828-850-4570
Mailing Address - Fax:
Practice Address - Street 1:618 2ND ST NE
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-3856
Practice Address - Country:US
Practice Address - Phone:828-850-4570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL001903133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered